One of the primary benefits of your Medicare coverage is how comprehensive it is. Generally speaking, if a doctor says that the service or item is medically necessary, you have a good argument for it to be covered by Medicare. This is the case for many medical services and equipment.
But, as with many things in life, there are alternatives out there. Medicare Advantage is an alternative to Original Medicare. Veganism is an alternative diet. Similarly, there is alternative medicine, sometimes called holistic medicine, that acts as another option to traditional medicine. If you fall into the population that prefers this alternative, does your Medicare coverage work, or do you need to find alternative sources of coverage?
What Counts as Alternative or Holistic Medicine?
“Alternative medicine” is an umbrella term for different medical practices or theories that fall outside of the generally accepted medical orthodoxy. When used in conjunction with traditional medicine it is sometimes called complementary medicine. It’s also been called holistic medicine, since it often focuses on treatments for the whole person — mind, body, and spirit. There are many different types of practices that fall under the term “alternative medicine,” from special diet to meditation to yoga. The services can also range from the medically grounded massage therapy to the more spiritual reiki. The most commonly practiced alternative medicine is called “natural products,” which includes dietary supplements and vitamins. You may even practice it. (Have you ever taken vitamin C to combat a cold?)
With such a wide range of services that fall under alternative medicine, the general effectiveness is difficult to verify. While some alternative medicines have some scientific backing that show their value as a treatment option, others have been called ineffective or even dangerous depending on the treatment. If you’re interested in an alternative treatment option, make sure you consult with your doctor, do your research, and work with a professional so that you’re taking every necessary precaution.
Does Medicare Cover Alternative Medicine?
If you do decide to try out an alternative medicine, you may be wondering if Medicare will cover it. Unfortunately, it’s impossible to give a definitive “yes” or “no” since the fields of treatment for alternative medicine are so broad. We can say that the answer will more often than not be “No, it’s not covered by Medicare.” The reason for this is that there really isn’t enough evidence to support Medicare covering these services. There are exceptions to this, but for most services, you won’t likely receive coverage.
What does this mean for you, in terms of coverage? Well, we’ll cover some of the exceptions later, but for the services that aren’t covered by Medicare, you have a few options. One Medicare-related option is to enroll in a Medicare Advantage plan. While it’s impossible to say that all types of alternative medicine will be covered, some aspects of holistic medicine or alternative medicine services may be covered. This varies from plan to plan, though. You can also try documenting your alternative care usage and asking to receive reimbursement through Medicare. The alternative medicine practitioner may be able to help you to get the documentation Medicare requires for reimbursement. Remember, you’re essentially appealing Medicare’s coverage decision, so a referral from your doctor and all relevant documents will help, but your claim can still be denied. If your coverage options fall through, some practitioners may be willing to work with clients to come up with payment plans or discounted rates.
What Types are Covered?
Some types of alternative medicine are covered by Medicare, luckily though, these usually require a doctor’s referral or need to fit special circumstances. One of the more well-known alternative medicine practices that Medicare offers coverage for is acupuncture. Acupuncture is a central practice in traditional Chinese medicine that inserts thin needles into strategic points of the body. Traditional Chinese beliefs say it balances the body’s chi, while modern medicine has shown that acupuncture activates nerves, muscles and tissue. Some evidence does point to acupuncture helping with pain relief, though the body of evidence is small. Medicare Part B covers acupuncture for 12 appointments in 90 days if the beneficiary has chronic lower back pain, defined as lasting 12 weeks or longer and there’s no identifiable cause related to an illness, surgery, or pregnancy. It must also be administered by a doctor or qualified health care worker.
There are other services that can be considered alternative medicine, since it’s such a broad category. Medicare will cover medically necessary chiropractic services from a qualified practitioner, various pain management therapies, some dietary or nutritional therapies, and some behavioral therapy or mental health treatment. Many Medicare Advantage plans can even help cover gym memberships.
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When many people hear the phrase “alternative medicine,” they picture snake oil practitioners of quack science who promise to solve your medical woes with practices that have little evidence to support them. What they don’t picture are practices aimed at treating your entire body, incorporating aspects of healthy dieting, exercise, and mental health, along with the more fringe practices. While these out-of-the-ordinary medical alternatives aren’t usually covered by Medicare, you do have ways to try to receive financial help if you need it. And, keep in mind that well-established alternative treatments may surprisingly be covered! Check with your specific plan or coverage to be sure!